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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

CMS Issues Revisions to Proposed Hospice Cost Report, Seeks Input – Comments due Dec. 23 NAHC/HAA Provide Analysis, Guidance

December 18, 2013 10:30 AM

As reported previously (see NAHC Report, Nov. 25, 2013), the Centers for Medicare & Medicaid Services (CMS) continues to move forward with plans to significantly alter the hospice cost report to collect expanded data that will be used in future years for payment reform.  While the proposed hospice cost report will be applicable to only freestanding providers, CMS will implement comparable changes for facility-based hospices following finalization of the freestanding hospice cost report revisions.  In response to comments on the initial cost report changes issued in April, CMS has made a number of modifications; however, concerns remain about this substantial expansion of reporting requirements and its impact on hospice providers.  The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) have met with experts in the field to assess the modifications that CMS has made and to identify additional changes that would provide greater clarity, consistency, and ease for hospice providers.  HAA and NAHC’s Home Care and Hospice Financial Managers Association (HHFMA) have also worked with experts in the field to develop suggested edits for use by Medicare’s administrative contractors (MACs) to ensure greater consistency and accuracy in cost reporting.

It is clear that CMS gave close consideration to industry comments submitted earlier this year. Among the changes that CMS incorporated into the revised proposed cost report are:

  • Delay in the effective date from cost reporting years beginning on or after Jan. 1, 2014, to those beginning on or after Oct. 1, 2014
  • Elimination of the average length of stay calculation from the cost report (based on concerns that the calculation was not accurate and consistent with the long-standing calculation formula used by hospices)
  • Elimination of reporting of over-the-counter drugs
  • Moved certain counseling activities to the Direct Patient Care Service Cost Centers;
  • Greater detail in some sections of the instructions
  • Added physician administrative costs as a General Service Cost Center
  • Modified certain statistics to better reflect realities of hospice operations (e.g. changed measure for laundry and linen from pounds to facility days)
  • Added cost report preparer information
  • Added a statement of changes in fund balance

CMS has developed a document that lists major comments and its response to the comments that is available HERE. (As of this publication date the document had not yet been supplied on the CMS website.)

Key Issues to be Addressed
NAHC/HAA are developing comments on the most recent version of the proposed cost report.  Two companies with expertise in the field (The Health Group and Simione Consultants) have developed formal comments and gave permission to make their comments more widely available to those who may also be interested in submitting comments (The Health Group and Simione Consultants).  It is strongly recommended that prior to including any of these comments as part of your submission that you ensure that you are in agreement with the recommendation in question, since there may be disagreement in the field over how CMS should address some issues.   Following are some general concerns that NAHC/HAA will be including in its comments:

  • NAHC/HAA believe it essential that hospices submit accurate and timely data, and are committed to conducting considerable outreach and education to the hospice community on the expanded hospice cost report.  We urge that CMS and its administrative contractors (MACs) also engage in outreach to ensure that hospices receive frequent reminders that the new cost report will require a considerable effort to master, and that hospices should begin the process of adapting their operations and systems to capture the more detailed data at least six months prior to the first applicable cost reporting year.
  • NAHC/HAA continue to take issue with CMS’ estimates of increased burden under the revised cost report.
  • It appears that CMS gave no consideration in its estimates to the operational and systems changes needed to comply with the new cost report requirements. Hospices will need to engage all members of their financial staffs as well as clinical and operations staff to ensure that data is being collected and attributed in a consistent and accurate manner.
  • Given the vast expansion of activities that will be associated with gearing up for the new cost (including the development of educational guidance, adaptation by the hospice, and systems changes) and the fact that additional changes are needed that may result in further delays of finalization of the new cost report, timing of a finalized cost report issuance is unknown, we strongly urge that CMS allow a minimum of nine months following finalization of the requirements for hospices to adapt.  It should be noted that hospices are in the midst of adapting to a number of other significant changes that should be considered in establishing the new effective date.
  • We have continuing concerns about inclusion of pharmacy as a general service cost center and urge CMS to more appropriately establish pharmacy as a direct patient service activity.
  • While we appreciate that under cost reporting rules agencies may request permission of their MAC to utilize an alternative statistical basis, the timing and conditional nature of this process is ineffective under the circumstances.  Hospices will need to know, as they are collecting their data to comply with the cost report, what statistical basis they will be using. We very strongly urge that CMS develop a more streamlined and automatic means for hospices to employ an alternative basis.
  • We also appreciate CMS' sensitivity to concerns that the average length of stay statistic in use under the current cost report requirements is inaccurate. We do, however, believe that this statistic, if calculated properly, can be of some use to hospices, the industry, and policy makers.  For this reason, we would recommend that ALOS data be calculated and available from some source -- CMS might consider including it either in the cost report or, if appropriate, as part of the PS & R.
  • Relative to physician administrative services, we believe that additional consideration should be given to the forms and instructions to ensure that proper classification of costs is addressed.  Physician administrative services should not be allocated to non-reimbursable costs.  
  • Level 1 and 2 edits.  CMS has made clear that a major driver behind revision to and expansion of data collection under the hospice cost report is to ensure more accurate data is available with which to develop future payment changes.  Under these circumstances, we believe that the hospice industry would be best served by inclusion of targeted edits that will assist the hospice in ensuring internal consistency and greater accuracy of cost reporting.  We appreciate that CMS has indicated that such edits are currently under consideration.

New Chart of Accounts
Given the broad expansion of data collection required under the proposed cost report, most experts in the field believe that hospices will need to revise their chart of accounts to ensure access to more detailed data.  During 2012 a subgroup of NAHC’s Home Health and Hospice Financial Managers’ Association (HHFMA) led by Pat Laff of Laff Associates developed a uniform chart of accounts for hospice.  As part of the process the group consulted with CMS staff regarding the expenses accounts and the accounts definitions related to each level of care that were included in the chart of accounts.  The chart of accounts is freely accessible to all hospice organizations online at  

To Submit Comments
Comments on the most recent proposed version of the hospice cost report must be received by Dec. 23, 2013 (comments should include the document identifier-- CMS-1984-14 or OMB control number –0938-0758 and may be emailed to ).

It is uncertain how much time will elapse between the closing of the comment period and CMS’ next action, but given CMS’ desire to make the new cost report effective with cost reporting years beginning on or after Oct. 1, 2014, it is important that freestanding hospices begin to prepare now to:

  • substantially increase their accounting capabilities (see NEW CHART OF ACCOUNTS, above);
  • conduct strategic planning regarding their accounting process;
  • conduct strategic planning on how the cost report will be prepared (this will vary by provider); and
  • take advantage of forthcoming educational opportunities on this topic (NAHC will offer in-depth training during spring 2014; announcements will be forthcoming in NAHC Report, Hospice Notes, and on the NAHC member listservs).



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